Cultural Awareness - 360 Degree Feedback Survey Sample #12

360 Feedback Survey

Instructions

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

Cultural Awareness

• Shows respect in daily interactions
• Fosters a diverse workforce free from discrimination and harassment.
• Encourages a work environment where individual differences are valued.
• Seeks out different viewpoints and benefits from different perspectives.
• Respects others regardless of age, race, gender, nationality, or disability.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Problem Solving

• Able to balance the needs of different people in a solution to a problem.
• Effective in solving problems.
• Works cooperatively with others to solve problems.
• Identifies and assesses all potential responses to a problem.
• Is a good problem solver and decision maker

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Technical

• Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices
• Demonstrates mastery of the technical competencies required in his/her work.
• Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
• Knows how to produce high quality products/work.
• Seeks information from others as needed.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Objectives

• Organizes and schedules events, activities, and resources.
• Encourages me to take on greater responsibility.
• Sets long-term and short-term goals.
• Able to organize work.
• Works toward achieving established goals and objectives.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Trustworthy

• Takes care to maintain confidential information.
• Delivers on promises made.
• Is a person you can trust.
• Demonstrates a sense of responsibility and commitment to public trust.
• Communicates an understanding of the other person's interests, needs and concerns.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


Please give any final comments or suggestions for [Participant Name Here]'s assessment.